AdultBasic and the 41,000 Pennsylvanians who lost health insurance in 2011

I recently got to meet José Parra of Phoenixville, at the Daily Local News’ 156th PA House district debate on October 23. As a personal effort to help low-income people who have trouble finding affordable health insurance, José is spreading the word about the consequences of the state’s discontinuation of the adultBasic health care program (in which he himself had been enrolled) on Feb. 28, 2011. He kindly let me interview him by phone on October 30, 2012. Q’s and A’s follow.

How long were you on adultBasic?

At least 3-4 years.

How did you qualify for adultBasic?

It was based on income. I had a job, and still have it, at a Community College. My employer offers no health care. So I had to insure myself, which obviously is costly, but fortunately I applied successfully for adultBasic coverage.

Was it helpful to you?

Yes, very helpful. I had to pay small amounts when I got care, and in March 2010 the copay went up, but it was still reasonable, with $50 for an emergency room visit. For any prescriptions I was able to use discounted generics.

Some people, those without any medical coverage, don’t pay anything for the ER, if unemployed or have government or state assistance. The Phoenixville Hospital has charity care.

But I felt good paying what I could, not being a charity case. I went to a doctor I liked.

Do you think people overuse free or low cost care?

Not that I experienced. I needed blood work every 6 months to check if my medications were working and if they had affected my liver. I had a cholesterol problem, and still have it. I’m still taking the meds, which now my mother brings from South America—she can get them a lot cheaper there. But I don’t know if the meds are working, though I have taken them for years, and my blood work in the past showed good cholesterol levels, I never had liver problems. I was last checked at the end of 2010, before my insurance ran out in 2011. Any doctor would check it but I can’t afford it.

I’m in my 50’s, I should have a physical once a year, and haven’t. They should check my prostate, my colon, etc. I had the prostate checked under adultBasic but no colonoscopy.

Could you have better or even cheaper medical care if you didn’t have a job?

Maybe; but I didn’t qualify.

Why did adultBasic end about a year and a half ago?

AdultBasic started in 2001 with the state’s tobacco settlement money. It was supposed to remain solvent for 25 years. I read in the Daily Local News in April or May 2011 that people were suing the state. I wanted to be part of the suit but lost track of the article.

AdultBasic was started under the Ridge administration. Corbett cut it off, the Republicans voted against it.

Where did the tobacco money that was funding it go?

I don’t know where the money went.

What options remained for you? How practical and affordable were they?

The closest was a county-assisted program; I looked into them all, but couldn’t afford any.

Was the state legislator where you live helpful?

I talked to Rep. Kampf, who said would not support restoring adultBasic. He moved right to alternatives. He didn’t seem to grasp that other programs cost more than I could pay.

One program, the best for me, cost $160-180/month. It just wasn’t practical. The whole idea of AdultBasic was affordability. It let people avoid ER’s, and assured that they got care in the right places.

So, what did you do?

I’ve been trying to get coverage. I’ll reapply for programs. If I’m really sick I’ll use the clinic in Phoenixville, which is only for those who live here. It’s a non-profit agency, and doesn’t cover everything. It doesn’t cover hospitalization, X-Rays, etc.

Why should we have to use a non-profit when our own government won’t help?

I had a serious heart infection, myocarditis, and almost died. I started in intensive care and was hospitalized for days; they did catheterization and checked for blocked arteries. It was all paid by adultBasic. I paid nothing for the hospital.

The non-profit wouldn’t have covered that: the ER, medical staff, etc. It would have cost me a lot.

Did you see Michael Moore’s movie Sicko, where the man had the ends of 2 fingers cut off and they gave him a price to have each one sewed back on? He didn’t have any insurance.

Has the private sector been helpful?

No, not at all.

You said when I first called you that you’ve been sick for a few days; did you get any medical attention for that?

I did go get medicine for a cold, and vitamin C. I didn’t see a doctor. I haven’t needed to go to the ER I since lost insurance, and that’s lucky.

What do you think the state should do to help people?

They should help with health. My mother in South America gets reasonable insurance and good health care. Sicko asks: why do other countries do better? Canada, France…. In many countries doctors even come to sick people’s houses. I’ve seen lots of injuries that could have been settled by a house call, not ER.

I’ve been to the ER a lot, with other people. The other day I took a person to the ER to translate. I volunteer; I met Hispanics and wanted to help them. I just helped facilitate a rental with a landlord. It’s important to find common ground between individuals. I help sometimes with immigration, connect people with a good immigration lawyer, and often go to translate or support people, even though lawyer knows Spanish.

Are you totally bilingual, to be able to help people in those ways?

Yes, I came here at two years old; I remember JFK airport. Mom said we lived first in Union City NJ and I went there and recognized the street. Then we moved to Jersey City, California, Jersey City again, Pennsylvania. I’ve been in Chester County since the 1970s, in various towns. Sometimes I visit former the houses: Berwyn, Devon, Malvern, West Chester.

I’m a US Permanent Resident, I would like to be citizen, and will apply when I can afford it. I want to help the Hispanic community. I can’t vote yet but can support candidates. Politics affects my people. I met with Bret Binder before the debate I attended. The Hispanic community needs better representation.

Why should society help people to get regular medical care and check-ups?

Everybody is entitled to the right to a doctor and have medical needs met. We have to help people; help should be there. But now that idea goes against the norm. I was helped by tobacco settlement money and I paid a portion, what I could afford. People should pay to their ability. No one wants to be a charity case.

Will you be covered in 2014 by the Affordable Care Act (if it still exists then)?

Yes, but I don’t know the cost to me. Some Medicare money will help cover, I know. Today I don’t qualify for Medicaid or Medicare. Preventive care will help everyone, and the system should reduce serious sickness. It was important to eliminate the preexisting conditions exclusion. You can’t support only part of the ACA. I support the board that would cut down abuse.

Affordable prescription plans are hard to get today. I can’t get new more effective brand name medicine right now, because it’s too expensive for me.

How did you happen to be at the debate where we met?

I support Bret Binder, and Paul Drucker in the district where I live. I will support candidates who are for things like affordable care, immigrants trying to get their papers together, people who need services. My goal is to think of beyond the district where I live. Whatever comes about in legislation involves more than one individual.

I went to another debate before last week’s, and ran into Bret. I talked to Bret about Hispanic issues. Bret was glad to meet, and we had lunch in a Hispanic setting. Bret got to chat with a Hispanic voter and business owner and listen to her concerns.

Bret said to email him the adultBasic info I wanted him to see; I thought he was easier to talk to and asked good questions.

In their debate, to the question I asked, Bret said he would help try to reinstate adultBasic. Dan Truitt said it’s an unfortunate situation but the state just needed to cut a lot of services. Why does that apply to adultBasic, when the taxpayers weren’t paying for it? He said I was welcome to talk to him in his office, but the information is on the web site. We have to solve the problem of good affordable health care.

I also support Manan Trivedi, who has the interest to help out on immigrant situations.

End of Interview

My notes on the 10/23/12 156th debate show on this question, summarizing what was said:

Q: The state cut adultBasic funding; what is your stand on that and the Affordable Care Act?

Dan Truitt: I didn’t want adultBasic gone. But other programs kick in. Half my job is talking to constituents; they can come and see me. Helping with the end of adultBasic is part of that. In the 2011 budget the prior administration left big holes. We need to get people working again; that’s a priority next term.

Bret Binder: Fiscal responsibility is not just cutting. Spending money can save later. I appreciate this as a small business owner. I am against those cuts. The federal stimulus went away, true; but this administration put more into corrections that should have gone elsewhere.

If anyone has any questions about adultBasic or other things that José and I talked about, he is happy to be contacted at alumini337@aol.com.

I’ve been looking around on the web, trying to educate myself more about these issues. One of the things José and I discussed was why the state cut off adultBasic when the tobacco money is scheduled to last till 2026. I found a lot laid out in this article by two lawyers who actually sued the state on behalf of individuals like José (this must be the suit José mentioned):

Bring back adultBasic: Pennsylvania owes the working poor benefits promised by the Tobacco Settlement Act
Pittsburgh Post-Gazette
First Published September 5, 2011 [which was Labor Day]
By William R. Caroselli and David S. Senoff

…it’s ironic that right now in Pennsylvania, at the same time we’re recognizing the contributions of working families, we’re also marking the six-month anniversary of an act by the governor and the state Legislature that inflicted perhaps more pain on working families than even the current economic recession.

On Feb. 28, our elected officials refused to continue using tobacco settlement money, not taxpayer money, to fund the adultBasic health care program, eliminating a successful, effective health care program, and taking away the only health care option available to many of Pennsylvania’s working poor.

The working poor are, as the name implies, people who have jobs but who make so little that they fall below the poverty line. For the most part, these folks work jobs that don’t offer health care and earn so little that most private health care options are priced out of their reach.

AdultBasic was created as a solution. It allowed low-income workers to purchase health care insurance at a minimal cost. This was no handout. Participants paid premiums that were kept low thanks to the use of funds Pennsylvania receives in annual settlement payments from tobacco companies. The settlement payment amount for fiscal year 2009-2010 was more than $340 million.

The Pennsylvania Tobacco Settlement Act provides that the tobacco settlement monies would be “used to make Pennsylvanians healthier and provide for the health of future generations of Pennsylvanians,” and specifically that 30 percent of the proceeds would be shared between adultBasic insurance and Medicaid for workers with disabilities.

So at no cost to taxpayers, Pennsylvania’s working poor were allowed to purchase health care at premiums of approximately $40 month.

When the governor and Legislature used the tobacco settlement money for their political priorities, 41,000 low-income, working Pennsylvanians were left without health insurance, and another approximately 500,000 Pennsylvanians were removed from the waiting list.

Why would our elected officials blatantly disregard Pennsylvania law to take tobacco settlement funds away from the adultBasic program when it’s been proven an effective way to provide affordable health care coverage to working families and individuals without using money from the Pennsylvania General Fund?

That answer is unclear and that’s why we’re taking Gov. Tom Corbett, his administration and the Legislature to court. Sometimes the only way to hold government accountable is to force them to do the right thing.

The fact is that the alternatives are unacceptable. One option is for the government to do nothing and allow thousands of low-income, working Pennsylvanians to simply go without coverage, which drives up health care costs for everyone else.

Another option is what Gov. Corbett calls “Fair” Care. But it requires the working poor shoulder a sevenfold increase in premiums. What’s fair about that?…

William R. Caroselli and David S. Senoff are partners with the Pittsburgh law firm of Caroselli, Beachler, McTiernan and Conboy

I have since learned, by inquiring to that law firm, that the suit is ongoing, that on 1/9/13 a Commonwealth Court judge will hold a class certification hearing and hear a motion for special relief, and that there is a realistic chance that the discontinuation of adultBasic will at some point be ruled unconstitutional.

2) Another article, “Lawsuit: State illegally ended health insurance program for low income adults “ by Jo Ciavaglia, PhillyBurbs.com, 3/16/11, tells us where the tobacco money went: for health-related expenses, but apparently not the ones specified in the settlement. Well worth reading.

3) And “Gone, but not forgotten Gov. Corbett” by Jo Ciavaglia, PhillyBurbs.com, September 1, 2011.

As the January hearing approaches, we can look for a revival of interest in the fate of adultBasic and the 40,000+ Pennsylvanians (plus waiting list) whose health care has been affected by the discontinuation of the program.

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About politicswestchesterview

Nathaniel regards himself as a progressive Democrat who sees a serious need to involve more Americans in the political process if we are to rise to Ben Franklin's challenge "A republic, madam, if you can keep it," after a passerby asked him what form of government the founders had chosen. This blog gives my views and background information on the local, state, and national political scenes. My career in higher education was mainly in the areas of international studies, foreign languages, and student advising, most recently at Franklin & Marshall College in Lancaster, from which I retired in 2006. I have lived in West Chester since 1986.
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3 Responses to AdultBasic and the 41,000 Pennsylvanians who lost health insurance in 2011

  1. Stephanie says:

    Nathaniel, this was very informative. I didn’t know a lot about AdultBasic. I hope the courts rule its defunding as unconstitutional.

  2. Pingback: Court upholds rule of law and Adult Basic Care | politicswestchesterview

  3. Pingback: Court upholds rule of law and adultBasic Care | progressivenetwork

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